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In This Issue of JAMA |

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JAMA. 2016;315(5):435-437. doi:10.1001/jama.2015.14084.
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In a randomized, placebo-controlled clinical trial involving 60 patients with chronic sinusitis with nasal polyposis refractory to intranasal corticosteroids, Bachert and colleagues assessed the efficacy of 16 weeks’ treatment with subcutaneous dupilumab—an interleukin 4 and 13 inhibitor—added to mometasone furoate nasal spray (MFSN) on reduction of nasal polyp burden. The authors report that compared with mometasone alone, the addition of subcutaneous dupilumab reduced endoscopic nasal polyp burden after 16 weeks.

Acetazolamide has been used for decades as a respiratory stimulant in patients with chronic obstructive pulmonary disease (COPD) and metabolic acidosis. In a randomized, placebo-controlled trial involving 380 patients with COPD and metabolic acidosis who were receiving invasive mechanical ventilation, Faisy and colleagues found that use of acetazolamide did not result in a statistically significant reduction in the duration of invasive mechanical ventilation.

In cross-sectional analyses of data from 286 deceased participants in a clinical neuropathology cohort study, Morris and colleagues examined relationships between seafood consumption, brain mercury levels, and brain neuropathology. Among the authors’ findings was that moderate (weekly) seafood consumption correlated with a lower burden of Alzheimer disease neuropathology. Seafood consumption was correlated with higher brain levels of mercury, but mercury levels did not correlate with brain neuropathology. In an Editorial, Kröger and Laforce discuss the evidence that mercury contamination of fish does not diminish potential cognitive benefits of seafood consumption.

Expiratory central airway collapse, which has been associated with cigarette smoking and chronic obstructive pulmonary disease, is hypothesized to increase respiratory morbidity. Bhatt and colleagues assessed this relationship in an analysis of paired inspiratory-expiratory computed tomographic images from 8820 participants in a study of current and former smokers. The authors report that expiratory central airway collapse—identified in 443 patients—was associated with worse respiratory quality of life.


Chronic tinnitus negatively affects the quality of life of many adults. In a randomized, placebo-controlled trial reported in JAMA Otolaryngology-Head & Neck Surgery, repetitive transcranial magnetic stimulation (rTMS) reduced symptoms of chronic tinnitus—at the end of treatment and at 6 months’ follow-up. In this From the JAMA Network article, Piccirillo discusses rTMS treatment for chronic tinnitus.

A woman presented with an erythematous, scaly, nonpruritic, and painless rash that had begun 3 months previously on her arm, subsequently spread to her back, chest, and groin and that worsened during warm weather. Examination revealed annular plaques with central clearing on her chest, back, and flanks. Examination of the feet revealed scale and maceration between the toes. What would you do next?

This Medical Letter on Drugs and Therapeutics article summarizes recent data on the safety, stability, and potency of drugs when used beyond the manufacturer’s designated expiration date. Most drugs have a shelf life of 1 to 5 years; however, evidence suggests many solid dosage formulations stored under reasonable conditions in unopened containers retain their potency for at least 5 years after the label expiration date.



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